Surgical Outcomes of Different Approaches in Treating Boerhaave's Syndrome

不同手術治療方式對於Boerhaave's Syndrome癒後的影響：文獻回顧及本院經驗

李佳穎(Chia-Ying Li) ； 李章銘(Jang-Ming Lee) ； 黃培銘(Pei-Ming Huang) ； 李元麒(Yung-Chie Lee)

《胸腔醫學》 25卷4期 (2010/08) Pp. 168-174

https://doi.org/10.29806/TM.201008.0001

摘要

前言：Boerhaave's syndrome是指自發性的食道破裂，是一種及少見但致命的疾病。目前對於此疾病的治療方式尚未有一致的共識。本文回顧近幾年的文獻以及整理本院治療此疾病之經驗，以期能找到在不同狀況下較適合的治療方式。
方法：本文回溯性回顧台大醫院於2000年至2006間被診斷為Boerhaave's syndrome並接受手術的病人之術式、癒後及影響癒後之相關因素。
結果：共有兩位女性及六位男性病患被診斷為Boerhaave's syndrome。其中四位病患接受T型管頸部食道排除(exclusion)、胸腔鏡膿胸剝除(decortication)及引流性胃造口手術。兩位病人接受食道排除手術（藉由頸部食道造口及胃造口）。一位病患接受直接食道修補手術(primary repair)。另一位病患因病況較差，只接受胸管引流及引流性胃造口手術。所有病患中有兩位病患因為延遲的手術治療後來因敗血症而死亡。
結論：只要早期診斷再加上適當的手術治療，Boerhaave's syndrome是一個可以被成功治療的疾病。T型管頸部術在食道排除手適合的病人身上是一個可以暫時提供唾液排除引流而且只需要一階段手術的另一個選擇。

關鍵字

食道 ； 食道破裂 ； 胸腔手術

並列摘要

Background: Boerhaave's syndrome is a rare, devastating disease that results from spontaneous esophageal rupture. There is no consensus on the optimal treatment. We reviewed the literature and the data of our patients to determine the more optimal treatments for different conditions.
Methods: We retrospectively reviewed the clinical results of patients with Boerhaave's syndrome undergoing surgical intervention at National Taiwan University Hospital from 2000 to 2006.
Results: The patients comprised 2 females and 6 males, ranging in age from 51 to 87 years. Four patients received cervical esophageal exclusion with a cervical T-tube, video-assisted thoracoscopic surgery decortication and gastrostomy, 2 underwent esophageal exclusion by esophagostomy and gastrostomy, and 1 had primary esophageal repair. Another patient underwent chest tube thoracostomy, gastrostomy and jejunostomy only, due to a generally poor condition. Two patients died of profound sepsis because of delayed intervention.
Conclusions: Patients with Boerhaave's syndrome can be successfully treated with early diagnosis and adequate surgical intervention. Cervical T-tube esophageal drainage can provide a 1-stage operation for temporary saliva exclusion and a satisfactory long-term outcome in selected cases.

並列關鍵字

esophagus ； esophageal perforation ； thoracic surgery